Clinical Analysis Of Mitral Valve Replacement For Mitral Stenosis With Pulmonary Hypertension

Objective Pulmonary arterial hypertension(PAH)is one of the most common complications of mitral stenosis(MS),which severely affects the perioperative complications,mortality risk and long-term prognosis.Therefore,it is extremely important to improve the understanding,diagnosis and treatment of mitral stenosis with pulmonary arterial hypertension.Therefore,this study investigates the clinical effect of mitral valve replacement for mitral stenosis with pulmonary arterial hypertension of different degrees,and provides theoretical basis for perioperative complications,treatment and prognosis of mitral stenosis with pulmonary arterial hypertension.Methods Eighty patients with mitral stenosis complicated with pulmonary arterial hypertension undergoing mitral valve replacement from January 2011 to January 2018 in Cardiovascular Surgery Department of General Hospital of Ningxia Medical University were selected and divided into three groups according to the results of systolic pulmonary arterial pressure estimated by color Doppler echocardiography.Group A: mild SPAH group(30mmHg ? SPAP < 50 mmHg);Group B: moderate SPAH group(50 nmHg ? SPAP70 <mmHg);Group C: severe SPAH group(SPAP < 70 mmHg).Statistical analysis was carried out by variance analysis,two-to-two comparison of mean in variance analysis,chi-square test,rank sum test and variance analysis of block design.Results There were no significant differences in preoperative age,sex,history,preoperative left ventricular ejection fraction(LVEF),left atrial size and left ventricular diameter among the three groups(P > 0.05);preoperative NYHA classification of cardiacfunction,tricuspid regurgitation,mitral orifice area,mitral transvalvular pressure difference,pulmonary arterial pressure and mitral orifice blood flow velocity had statistical significance(P < 0.05).There was no significant difference in the type of valve replacement,size of valve,maze operation,cardiopulmonary bypass time and aortic cross clamp among the three groups(P > 0.05);the time of mechanical ventilation,ICU time and hospitalization time after operation had statistical significance(P < 0.05);the hospitalization cost among the three groups(P > 0.05).The hospitalization cost of severe pulmonary arterial hypertension group was higher than that of moderate and mild groups by variance analysis had statistical significance(P < 0.05).There was no significant difference in heart rate arrhythmia,incision infection and death among the three groups(P > 0.05),but there was significant difference in pulmonary infection and pericardial effusion among the three groups(P < 0.05).There were significant differences in right ventricular diameter,mitral transvalvular pressure difference and mitral flow velocity among the three groups before,2 weeks after and during the follow-up(P < 0.05),but no significant differences in ejection fraction among the three groups before,2 weeks after and during the follow-up(P > 0.05).After mitral valve replacement,there were significant differences in pulmonary artery pressure recovery before and 2 weeks after mitral valve replacement,preoperative and follow-up(P < 0.05).Conclusion Mitral stenosis combined with severe pulmonary arterial hypertension affects cardiac function,right ventricular diameter and tricuspid regurgitation before operation.Severe pulmonary arterial hypertension patients predict higher mechanical ventilation time,ICU time,hospitalization days and hospitalization costs after operation.Postoperative pulmonary infection and pericardial effusion are more likely,but right ventricular diameter,mitral transvalvular pressure difference and mitral orifice blood flow velocity can be significantly decreased after operation.During the follow-up period,some patients in severe pulmonary arterial pressure group recovered to normal,but the recovery rate was lower in mild and moderate groups.Therefore,patients with mitral stenosis and pulmonary arterialhypertension should be treated early.